Risk factors     Personal characteristics         Psychopathology Over 90% of youth suicides have at least one psychiatric disorder. The most common include depression, substance abuse, borderline or schizotypal, antisocial, disruptive (i.e., conduct disorder and impulsive), and psychotic.         Prior suicide attempts It is the best predictor of future death by suicide.         Cognitive and personality factors Hopelessness, impulsivity, poor interpersonal problem-solving skills, and aggression.         Sexual orientation Homosexual and bisexual youth exhibit more suicidal behaviors.     Family characteristics         Family history of suicidal behavior Greatly increases risk of completed suicide, although the mechanism for transmission is unclear.         Parental psychopathology Association with suicide risk is unclear but is important in assessing parental ability to maintain a safe and nurturing home environment.         Parent–child conflict Low parental acceptance and high parental rejection may increase suicide risk.     Adverse life circumstances         Stressful life events For example, disciplinary problems, breakup with significant other, and parent–child conflict.         Physical and sexual abuse Moderate association exists after controlling for other factors.     Socioenvironmental and contextual factors         Socioeconomic status Significant in African-American samples.         School and work problems Impairment and dropout.         Contagion/imitation Knowledge of peer suicide and media reports. Protective factors     Family cohesion Mutual involvement, shared interests, and emotional support.     Religiosity Inverse relationship between orthodoxy and suicide risk.     Friends Increases in importance with age.